Evidence map›Paper›PMID 32671799›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2021

Transient Biliary Fistula After Pancreatoduodenectomy Increases Risk of Biliary Anastomotic Stricture.

Thomas K Maatman, Alexa J Loncharich, Katelyn F Flick, Rachel E Simpson, Eugene P Ceppa, Attila Nakeeb, Trang K Nguyen, C Max Schmidt, Nicholas J Zyromski, Michael G House

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Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.4field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 12 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 2 institutions in 1 country.

Thomas K MaatmanDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA.
Alexa J LoncharichIndiana University School of Medicine, Indianapolis, IN, USA.
Katelyn F FlickDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA.
Rachel E SimpsonDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA.
Eugene P CeppaDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA.
Attila NakeebDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA.
Trang K NguyenDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA.
C Max SchmidtDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA.
Nicholas J ZyromskiDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA.
Michael G HouseDepartment of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 515, Indianapolis, IN, 46202, USA. michouse@iupui.edu.
Indiana University – Purdue University Indianapolis · USIndiana University School of Medicine

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBiliary fistula after pancreatoduodenectomy (PD) is associated with significant morbidity and mortality. The aim of this study was to determine the risk of early postoperative biliary fistula for developing biliary anastomotic stricture after PD.

methodsRetrospective review of all PD performed for various indications at a single institution between 2013 and 2018. Postoperative biliary fistulae were graded according to the International Study Group of Liver Surgery (ISGLS) as grade A-C. Multivariable analysis was performed for all comparative patient subgroups.

resultsA total of 843 patients underwent PD for malignant (68%) and benign (32%) indications. Postoperative biliary fistula developed in 66 (8%) patients; ISGLS grade A in 29 (3%), grade B in 32 (4%), and grade C in 5 (0.6%). Ninety-day mortality was 3% (25 patients). The remaining 818 patients were evaluated with a median follow-up of 16 months (IQR, 5-32 months). Biliary anastomotic stricture developed in 41 (5%) patients at a median of 10 months (IQR, 6-18 months) postoperatively. Strictures were managed with percutaneous (27 patients, 66%) or endoscopic (14 patients, 34%) stenting. No biliary stricture required operative anastomotic revision. Postoperative biliary fistula (HR, 4.4; 95% CI, 2.0-9.9; P = 0.0002) was associated with biliary anastomotic stricture; an increased risk for biliary anastomotic stricture was seen in patients with grade A (HR, 6.4; 95% CI, 2.4-16.9; P = 0.0002) and grade B (HR, 3.6; 95% CI, 1.2-10.9; P = 0.02) postoperative biliary fistula.

conclusionPostoperative biliary fistula after pancreatoduodenectomy, including clinically insignificant, transient biliary fistula, is associated with an increased risk of a late biliary anastomotic stricture requiring stenting.

Indexed as

Biliary FistulaPancreaticoduodenectomyAnastomosis, SurgicalConstriction, PathologicHumansPostoperative ComplicationsRetrospective StudiesTreatment OutcomeAnastomosis, surgicalAnastomotic leakBiliary tract surgical proceduresCholedochostomyPancreaticoduodenectomy

Identifiers

PMID32671799
OpenAlexW3043293776

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.